Empyema: Difference between revisions
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*#Fibrinopurulent - Loculations develop making resolution w/ single chest tube drainage unlikely | *#Fibrinopurulent - Loculations develop making resolution w/ single chest tube drainage unlikely | ||
*#Organizational - Takes several weeks to develop; "pleural peel" restricts lung expansion | *#Organizational - Takes several weeks to develop; "pleural peel" restricts lung expansion | ||
===Causes=== | ===Causes=== | ||
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==Clinical Features== | ==Clinical Features== | ||
* | *[[Fever]] | ||
** | *[[Shortness of breath]] | ||
*Anorexia | |||
*Night sweats | |||
*Pleuritic [[chest pain]] | |||
*[[Hemoptysis]] | |||
*Recent diagnosis and/or treatment for [[Pneumonia]] | |||
*History of penetrating chest trauma or diaphragmatic injury<ref>Barmparas G, DuBose J, Teixeira PG, Recinos G, Inaba K, Plurad D. Risk factors for empyema after diaphragmatic injury: results of a National Trauma Databank analysis. J Trauma. Jun 2009;66(6):1672-6</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*[[Pulmonary embolism]] | *[[Pulmonary embolism]] | ||
==Work Up== | ==Diagnosis== | ||
===Work Up=== | |||
*CBC | *CBC | ||
*CXR | *CXR | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Pulm]] | [[Category:Pulm]] | ||
Revision as of 18:06, 8 June 2015
Background
- Pleural space infections with + Gram stain/culture OR parapneumonic effusions without pleural fluid sampling
- Stages
- Exudative - Free-flowing pleural effusion amenable to chest tube drainage; may only last <48hr
- Fibrinopurulent - Loculations develop making resolution w/ single chest tube drainage unlikely
- Organizational - Takes several weeks to develop; "pleural peel" restricts lung expansion
Causes
- Pneumonia
- Complications of chest or abdominal trauma
- Esophageal perforation
- Extension from lung abscess
- Osteomyelitis or other near pleural infections
- Hemothorax, chylothorax, or hydrothorax that becomes infected
Clinical Features
- Fever
- Shortness of breath
- Anorexia
- Night sweats
- Pleuritic chest pain
- Hemoptysis
- Recent diagnosis and/or treatment for Pneumonia
- History of penetrating chest trauma or diaphragmatic injury[1]
Differential Diagnosis
Diagnosis
Work Up
- CBC
- CXR
- Thoracentesis
- Sputum Culture -- Acid Fast Bacilli (If TB suspected)
- Pulse Ox
- ABG interpretation
- Blood Cultures
Diagnosis
- Aspiration of grossly purulent pleural fluid on thoracentesis and at least 1 of the following:[2]
- + Gram stain or culture
- WBC count > 50,000 cells/µL (or polymorphonuclear leukocyte count of 1,000 IU/dL)
- Pleural fluid glucose <60
- pH <7.2
- LDH >1000 IU/mL
Treatment
- Treat underlying disease
- O2 if Hypoxemia
- Perform thoracentesis vs. chest tube if evidence of respiratory distress
- May need Video-Assisted Thoracic surgery (VATS)
- Antibiotics
- Piperacillin-tazobactam 3.375-4.5gm q6hr IV or imipenem 0.5-1gm q6hr
- Consider adding vancomycin if pt at risk for MRSA
Adult Chest Tube Sizes
| Chest Tube Size | Type of Patient | Underlying Causes |
| Small (8-14 Fr) |
|
|
| Medium (20-28 Fr) |
|
|
| Large (36-40 Fr) |
|
See Also
References
- ↑ Barmparas G, DuBose J, Teixeira PG, Recinos G, Inaba K, Plurad D. Risk factors for empyema after diaphragmatic injury: results of a National Trauma Databank analysis. J Trauma. Jun 2009;66(6):1672-6
- ↑ http://emedicine.medscape.com/article/807499-overview
- ↑ Inaba Et. al J Trauma Acute Care Surg. 2012 Feb;72(2):422-7.
- ↑ Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.